Collective Thinking 69

h HIV Futures Findings h Disclosure in the workplace h Women and HIV – Fighting the stigma

Collective Thinking The Newsletter for HIV+ people, their carers and supporters New Zealand ISSN 1170-2354

Issue 69 h May 08

“Kids Get Better” + The first Candlelight Memorial

e\ >?L ^Wi cWZ[ c[ WYj ed j^[ iW\[ i[n c[iiW][$ Co \Wj^[h mWi W ]Wo cWd m^e fWii[Z WmWo \hec 7?:I$É

2

?dh] 8]VebVc L^ccZg d[ HV[Z HZm EdhiZg 7dn '%%-! È7dn CZmi 9ddgÉ XViZ\dgn

lll#hV[ZhZmedhiZgWdn#Xd#co

BVg %-

COLLECTIVE THINKING Issue 69 H May 08

DAMNED IF YOU DO...

CONTENTS

When is the best time to come clean about my HIV status?

4 Local & International News

This question constantly arises for anyone living with HIV. But disclosure isn’t just an issue when you are in a relationship. Worries over disclosure will deter many from even considering going into a relationship in the first place.

There is really no way of knowing how the other person will react to the news. I have experienced for myself how someone who seems open-minded, knowledgeable and easy-going, and who initially seems OK with the disclosure, sometimes cannot handle a relationship with an HIV positive person after all. The rejection and disappointment is very painful.

Some people just freak, maybe because someone has made it very evident how easy it is to catch HIV or any other STI. Or some freak because it makes them realise something they only thought happens to other people is nearer to them than they think.

Whatever the reasons, all this makes it very difficult to decide when to disclose.

There is the “put it off as long as possible then disclose and hope for the best” approach. This may apply when you think you are on to a good thing and you want to hold on to it for as long as you can. People can often feel like this because early side effects of being HIV positive are voluntary and involuntary isolation.

Others try to avoid the torture and the emotional roller coaster of the above mentioned approach by ‘doing it right from the beginning’ and telling from the outset. That way you have lost nothing and can move on easily if the decision goes against you. There are those who make it a habit to have just friendly, platonic relationships (or so they try) and at the first signs of intimacy find a reason to put an end or stop to things. Some, even after several negative responses and experiences, still keep trying. This approach can be very draining on the soul and does little for one’s often already low self-esteem.

Of course you hear of the few who go off the rails completely and go on a rampage, not disclosing to anyone, telling themselves they will do to others what was done to them. In my opinion, this is not only a form of denial but also the sure road to selfdestruction, maybe even jail. Then there are those who are ‘once bitten, twice shy’ who mostly turn to other people living with HIV in the hope things will be easier; only to find out this raises a whole raft of new concerns.

That leaves those who just shut down completely, cut off all form of physical or sexual contact with others and try to fill their lives with other mental or spiritual pursuits.

I have often asked myself how I would have reacted to someone disclosing their HIV status to me before I was diagnosed; if I was on the receiving end of this information.

Honestly? It would have given me a lot of food for thought, so maybe I do understand being in the other person’s shoes.

It is only because I am in the situation that I am today, where I have been exposed to the amount of information that I have and knowing what I know now, I can think rationally about it. That is why I do not always take offence at people’s reactions and try to pass on the right information.

But having said all that, at the end of the day, it is an individual decision, in each unique situation. For those who have had things go their way (as in a relationship), I wish them continued success. And for those who have not had such a positive experience, keep trying; you never know if your next attempt might be a positive one. I don’t have an answer to when you should disclose but uppermost in my mind is the thought that you can’t take it back once you have said it. So, I suggest giving it careful thought, whatever the situation. But from my own experience, I know for sure, you are damned if you do and damned if you don’t.

Aaron McDonald

3 Letter from the editor

8 FEATURE STORY: “Kids get better” 12 FEATURE STORY: Putting a Face on AIDs – The first Candlelight Memorial 14 Precious Moments with the Dying 16 UPDATE: Burnett & Awhina Move 17 HIV Futures Survey Findings 18 HEALTH & WELLBEING: Living with HIV in 2008 22 HEALTH & WELLBEING: Combination Therapy 26 Disclosing HIV in the Workplace 28 OPINION: A Lad and His Dog 30 Women and HIV – Fighting the Stigma

3

(( LOCAL NEWS ))

Positive Women campaign against HIV stigma

4

On February 20, 2008 5 HIV positive women unveiled their faces as part of a public campaign to make New Zealanders question their assumptions about those living with the HIV virus.

Over the past two months, their profiles have appeared on buses, in women’s magazines, websites and postcards being distributed throughout the country as part of a destigmatisation campaign mounted by Positive Women Inc. Positive Women’s national coordinator Jane Bruning said the aim is to challenge the stereotypes by letting the women tell their own stories.

“Many people think HIV won’t touch them, that it’s a risk confined to specific sectors of our community,” she says. “We are saying the risk is a lot closer to home our faces and our stories are not so different to many New Zealand women.”

The stigma associated with HIV and AIDS is such that almost all HIV positive women keep their HIV status a secret, fearing negative reactions and discrimination against themselves and their families.

“The truth is that those living with HIV in New Zealand today are everyday people leading everyday lives,” she says. “No matter how a person contracts HIV, they shouldn’t have to deal with the added burden of stigmatisation on top of chronic health problems.”

HIV data collection up for debate Adding HIV to the Ministry of Health’s list of notifiable conditions will help create an “HIV census”, ensuring that anonymous data collection on New Zealand’s HIV and AIDS epidemic is secured for the future, says the New Zealand AIDS Foundation (NZAF).

NZAF is supporting moves in the forthcoming Public Health Bill to make HIV a “notifiable” condition, providing the current anonymous coding system is retained. AIDS has already been a notifiable condition since 1985 with no breaches of confidentiality.

“AIDS represents the end result of HIV infection, and with the effectiveness of new treatments for HIV, information on AIDS notifications are increasingly less useful as a tool for tracking the spread of the epidemic,” says Rachael Le Mesurier, Executive Director of the New Zealand AIDS Foundation.

New HIV diagnosis information is currently sent by GPs, sexual health clinics and NZAF centres to the AIDS Epidemiology Group at Otago University, who collate the sixmonthly AIDS New Zealand reports.

This system has been working very well since 1985 and has been entirely voluntary. Nearly 2,500 New Zealanders with HIV have given their permission for data on their diagnosis to be collected and published in AIDS New Zealand.

“The AIDS Epidemiology Group currently receives information on over 95% of HIV diagnoses, but there is no legal requirement for this data to be collected,” Le Mesurier says. “With the many demands placed on our health services, and the good news that treatments have drastically reduced AIDS deaths, we need to ensure that HIV is given the priority treatment it deserves by making the anonymous data collected secure for the future.”

NZAF is keen to point out that this data collection system has not and would not involve identification of HIV positive people.

“This is about collecting the ‘what’, ‘where’ and ‘how’ of new HIV infections, not the ‘who’,” Le Mesurier explains.

“The confidentiality of HIV positive New Zealanders must be protected.

“However, we need reliable data to map the changes in the HIV epidemic. For example, treatment-related deaths are a new complication that can only be monitored by analysing HIV diagnoses, rather than AIDS.” The Public Health Bill is currently before the Health Select Committee.

COLLECTIVE THINKING Issue 69 H May 08

New Wellness Fund launched A new Wellness Fund aimed at providing financial assistance for HIV positive people living in New Zealand was launched in late March by the New Zealand AIDS Foundation.

The needs-based service has been designed by the Foundation in consultation with people affected by HIV and AIDS nationwide, and is aimed primarily at covering healthrelated costs where alternative sources of funding are unavailable.

“Despite substantial improvements made over the last decade in the treatment of HIV, New Zealanders living with the virus continue to face significant and diverse challenges in maintaining their health and wellbeing,” says NZAF National Positive Health Manager Eamonn Smythe.

The Wellness Fund provides small grants of up to $750 per annum for those on low incomes.

These can be used to reimburse fees incurred by GPs, massage, podiatry, physiotherapy, osteopath, acupuncture, naturopathy, nutritionists, dieticians, or other health-related needs.

Special grants of up to $3,000 are on offer for healthcare or services which are not publicly funded, such as lipoatrophy treatment.

A third grant scheme (up to $500 per annum) reimburses travel costs related to attending New Zealandbased HIV conferences or travelling outside of your region to see an HIV specialist or NZAF counsellor.

“The Wellness Fund is maintained entirely through donations and bequests from the community,” Smythe says. “The New Zealand AIDS Foundation’s fundraising efforts, chiefly World AIDS Day, help to generate a significant part of this.”

For more information on the Wellness Fund, including funding criteria and application forms, please visit www.nzaf.org.nz . You can make an automatic $10 donation to NZAF by phoning 0900 RIBBON (742266) (you must be the bill payer).

HIV positive groups benefit from “Queen of the Whole Universe” funds The New Zealand AIDS Foundation says it is delighted to announce the distribution of $18,000 worth of funds raised in 2007’s “Queen of the Whole Universe” pageant to HIV positive peer support groups.

Body Positive Inc is to receive $9,000 for securing and importing “Aquamid”, a product which is used to reverse facial wasting on HIV positive people who suffer from lipoatrophy.

“Lipoatrophy can cause many of our members to feel like they are ‘wearing HIV on their face’,” says Bruce Kilmister of Body Positive.

“The Aquamid project will help make Body Positive participants feel once again confident in their appearance.

One Body Positive participant said he thought the improvement in the fullness in his face was instant: “My medication has made me healthier but my face belied that improvement,” he said. “People always told me I looked tired, which was not good for my self esteem, but now I feel great.”

Positive Women Inc is to receive $9,000 for the design and printing of promotional materials, such as posters and their Annual Report, as part of a continuing campaign to raise the profile of the organisation among key stakeholders and health care providers around the country.

“Growing the organisation’s profile is very important in order to increase our chances of receiving funding, as we are the only group working specifically on behalf of women and families living with HIV and AIDS in New Zealand,” says Jane Bruning, National Co-ordinator of Positive Women. “Through increased funding we will be in a better position to offer greater and improved services to our communities.”

“Queen of the Whole Universe – A Very Queer Beauty Pageant” is an annual fundraising event held for the benefit of the New Zealand AIDS Foundation.

Over 150 volunteers are involved in the making of this show, which has now raised over $100,000 for non-government funded NZAF projects and HIV positive peer support groups in the last four years. In 2007, the pageant raised just over $40,000, its largest total to date.

“Queen of the Whole Universe” will be appearing in Wellington for a special performance at Te Papa’s 10th anniversary celebrations on Saturday Feburary 16, and will return to Auckland’s Aotea Centre for a fifth year on Saturday November 15.

5

)) INTERNATIONAL NEWS ((

USA: University of Alberta Team Finds HIV Blocker Edmonton Journal (29.02.08)::Jodie Sinnema

6

In laboratory experiments, a gene that is part of the body’s natural immunity can block HIV from spreading late in the course of the disease. It is unclear, however, why the gene does not work this way in infected persons, according to researchers from the University of Alberta.

In cell culture, the scientists found the TRIM22 proteinencoding gene that blocks late-stage HIV from leaving cells and infecting healthy cells. While previous investigations have uncovered proteins that could block HIV during its early stages, the virus has been able to evolve and overcome them, said lead author Stephen Barr, who is with the university’s medical microbiology and immunology department.

“Although this particular gene can’t stop the virus from coming into cells, it can stop it from leaving cells,” Barr said. Barr said more research is needed to find out why TRIM22 does not stop HIV in the body.

The possibility of a drug or vaccine that might be able to activate it in humans is years away, however.

“This provides hope to HIV patients because it identifies a different part of the life cycle [of HIV] that drugs can be designed for, and perhaps a vaccine as well,” said Barr.

AUSTRALIA: Syphilis Testing Fails to Control Infection Rates Associated Press (18.02.08)::Tamara McLean

Rates of syphilis have increased sharply in Australia in the past decade, especially among gay men in their 20s and 30s. While some experts have speculated that the rise might be due to more men being tested for the disease, new research indicates the infection rate itself is actually rising.

To analyze the trend, epidemiologists at the MacFarlane Burnet Institute of Medical Research and Public Health in Melbourne compared the city’s testing and infection

rates. From 2002 to 2003, the chance of being tested for syphilis during a consultation with a general practitioner increased 44 percent. But over the same period, the syphilis diagnosis rate jumped by 500 percent.

“The increase in infectious syphilis notifications appears unrelated to the observed increase in testing and is more likely to be attributed to increased transmission,” the authors wrote, noting that increased testing does not appear to have stemmed the STD’s spread. “This suggests that testing and treatment alone may not be the only answer to a syphilis outbreak,” they said.

Health experts are calling for new prevention strategies to lower the syphilis rate among gay men.

In 2006, 815 new syphilis infections were recorded in Melbourne. The rise from 618 reports in 2004 constitutes an emerging epidemic that has the potential to climb to levels not seen in 30 years, experts worry.

For more information on syphilis, visit www.gettested. co.nz

SWITZERLAND: UNAIDS Calls for Lifting of HIV-Related Travel Restrictions Agence France Presse (07.03.08)

UNAIDS Executive Director Peter Piot said travel restrictions based on a person’s HIV status show the “exceptionality of AIDS.”“No other condition prevents people from entering countries for business, tourism or to attend meetings,” he said.

“No other condition has people afraid of having their baggage searched for medication at the border, with the result that they are denied entry or worse, detained and then deported back to their country,” said Piot.

Some 74 nations currently impose HIV-related travel restrictions, with 13 completely banning people with the disease from entering.

In addition, people living with HIV/AIDS while in their destination country can face deportation, “often without confidentiality and into situations of great discrimination and economic devastation,” UNAIDS said.

On Feb. 25 and 26 in Geneva, an international task force

COLLECTIVE THINKING Issue 69 H May 08

on HIV-related travel restrictions - including UN agencies and intergovernmental groups, civil society, and HIV/AIDS advocates - met for the first time. The task force intends to call for the lifting of travel-related bans at several upcoming meetings, including a high-level meeting on AIDS at the UN General Assembly in New York in June, and at the Global Forum on Migration and Development in October in the Philippines.

“We hope that their combined efforts will. influence governments to remove such restrictions,” said a statement from UNAIDS, which co-chairs the task force with the Norwegian government.

USA: Researchers Develop BreathMonitoring Device to Monitor Treatment Adherence Among HIV Positive People

Melker said treatment adherence decreases the likelihood that HIV will mutate into drug-resistant strains. He added that the device could help prevent the emergence of such strains. Health workers have tried several methods to monitor treatment adherence -- including log books and blister packs that record when the medication is taken -- but directly observed therapy, or DOT, is the only effective method, Melker said.

However, DOT often is inconvenient for patients and health workers, he added.

According to Melker, the new device could help address the issue by providing a new way to monitor treatment adherence. Melker said that although the current version of the device works well, he hopes that the technology eventually can be used in a cellular phone. He added that the device also could be used to track treatment adherence in people living with tuberculosis and other illnesses. Melker said that the potential implications of the device in helping health officials understand why some patients adhere to treatment regimens and others do not is “huge” (ANI/Thaindian News, 4/22).

Kaisernetwork.org (23.04.08)

Researchers at the University of Florida and Xhale have developed a breath-monitoring device that can detect whether people living with HIV/AIDS adhere to their treatment regimens, ANI/Thaindian News reports.

According to Richard Melker, a professor of anesthesiology at the University of Florida College of Medicine and chief technology officer at Xhale, the shoebox-sized device makes a beeping sound when it is time for HIV-positive people to take their antiretroviral drugs. If patients do not press a button to signal that they have taken their medication after five minutes, the device begins to beep at an increasingly louder volume until the button is pressed, Melker said. He added that if the button is not pressed after a set amount of time, the device can contact treatment coordinators to indicate that patients did not follow their treatment regimens.

The device also is programmed to record the results of a breath test that measures whether patients have taken their antiretrovirals. Patients can then take a memory card that contains data from the breath tests to antiretroviral clinics once monthly and receive a printed copy of their results, according to Melker.

FIJI: HIV In The Workplace Fijivillage.com (28.04.08)

More people need to be made aware of the seriousness of HIV and AIDS and its effects in the workplace.

These are the words of HIV Team Leader Sevuloni Ratu who conducted a 3-day HIV In The Workplace Workshop in Suva with 15 instructors from Labasa, Rakiraki and Lautoka, reports Fijivillage.com.

Ratu said the epidemic poses a major threat to the world of work because it affected the most productive segment of the labour force - those between the ages of 19 and 49 years.

Ratu added that based on the increasing number of people infected with HIV, it is important that there is wide coverage on this subject and by educating more workplaces on the impacts of this epidemic, it is expected that sensitization will bring about greater awareness and behaviour change.

According to the Red Cross there are currently 265 reported cases of HIV and AIDS in Fiji today.

7

>> FEATURE

“Kids get better” The impact of HIV and AIDS on children and families in New Zealand, as discussed with New Zealand’s leading paediatric infectious disease specialist, Leslie Voss

8

By Chris Banks

“Kids get better,” says Dr Leslie Voss, paediatric infectious diseases specialist at Auckland’s Starship Hospital, when I ask her why she chose to devote her medical career to working with children. “You see kids come in, they’re in hospital for a couple of days, and most of the time they get better and you never see them again.”

In treating adults, particularly those who are getting older, she perhaps means there can be a sense of postponing the inevitable. But working with children? Voss is making a difference right at the start of the human journey. It’s a career vocation that is punctuated by recurrent doses of hope and fulfillment.

The impact of HIV and AIDS was to prove the biggest challenge to Voss’s idealistic worldview, formed during her training at Otago Medical School in the early 1980s. AIDS was just beginning to emerge, and at the time it was not an issue that carried a child’s face – chiefly just three H’s: homosexuals, haemophiliacs, and Haitians, in recognition of the groups most affected globally at the start of the outbreak.

Voss’s first encounter with HIV and AIDS came during a stint in a Haitian hospital, after training in infectious diseases at the world-famous Mayo Clinic, which treats more than half a million people each year in the United States.

COLLECTIVE THINKING Issue 69 H May 08

“Once you’d made the diagnosis of HIV in these children, you just couldn’t do anything for them,” she recalls. “There were no drugs, no nothing. They were sent home to survive or die.”

“Once you’d made the diagnosis of HIV in these children, you just couldn’t do anything for them,” she recalls. “There were no drugs, no nothing. They were sent home to survive or die. The limited resources we had were not really able to be used on HIV infected children simply because they were going to die. It was a very difficult thing to live with. You had to be pragmatic.”

When Voss returned to New Zealand in 1993, she took up her role at Starship Hospital, caring for children with HIV and AIDS. Her first case proved to be as tragic as her Haitian experiences – a child who was diagnosed with an AIDS-defining illness and died soon after.

However, the advents of treatments like AZT (the first drug approved for HIV/AIDS treatment in the early 1990s) was a breakthrough. Voss’s next case was a family with an adopted child who was found to be HIV positive.

“She has actually had a remarkably straightforward, normal life and is now under the care of the adults. Apart from some fairly early admissions to hospital when she was quite young, after the age of five she hasn’t had any further admissions,”Voss says.

“She just came to clinic on a threemonthly basis, started on drug therapy when it became available, and she has an extraordinarily normal childhood and adolescence really. This is what I would like for us to achieve with most of our children.”

Good Pill Hunting Although that case had a happy ending, the road was not paved with gold. The difficulties Voss’s team had in obtaining HIV treatments for that patient reflects ongoing problems with children and medication, something which is not exclusive to the treatment of HIV. “When AZT first became available in 1993, it was only ever brought into the country as a tablet. Being a child, she needed it as a syrup,”Voss explains. “The paediatrician who was initially involved with me at that time had to struggle and fight the whole time to get the syrup made available in New Zealand, even though it was available elsewhere.”

As the number of possible HIV treatment medications

has bloomed, so too has the availability issue, with Voss often finding herself caught up in red tape just so she can write a prescription.

“Another example – one medication was funded in 200mg tablets, but most of the kids needed something like 60mg, so we had to get the syrup. Even though the tablets were funded, I had to apply every time for exceptional circumstance funding for the syrup, which I had to physically renew on an annual basis.”

Voss says the drug company concerned “didn’t see it worth their while bringing it in for the small volumes we needed for the children. They wouldn’t go through the process of getting funding approved for it. That went on for years.”

In other situations, Voss has been forced to change treatment regimes when a drug has suddenly become unavailable, information which in the case of one particular drug took the best part of a month to discover. “After much searching, we found the company had stopped bringing it into the Australasian region - it wasn’t available at all.”

Even in a world where the right medications are available, working out dosages for children – as in all paediatrics – is a complex procedure that is totally dependent on the individual. It’s worked out by weight and body surface area, meaning that dosages have to be revised every three months as children grow. There’s no such thing as a standard regime, as for most adults.

Vaccination against all the regular childhood nasties like measles, mumps and rubella can still be carried out, but under supervision.

“The child may not necessarily produce an adequate immune response, so say, if they get exposed to chicken pox or measles we recommend they come straight to hospital, and we usually give them immunoglobulin [a specially-concentrated antibody which can be used for intense, short-term protection against disease],”Voss explains. “The families are aware that they need to get immunoglobulin if they are exposed to those diseases. At the same time, some of our kids have had chicken pox and not had a particular problem. We do recommend routine annual influenza shots as well for the children.

9

>> FEATURE

Voss says the drug company concerned “didn’t see it worth their while bringing it in for the small volumes we needed for the children.

They wouldn’t go through the process of getting funding approved for it. That went on for years.”

Thankfully, the side effects of anti-HIV treatments which can have such a debilitating effect on adults are tolerated better by children. “The biggest problem with the children is not necessarily the side effects,” says Voss, “it’s actually getting them to take the pills.”

No Spoonful Of Sugar

10

On the surface, the problem of medication adherence for HIV positive children seems a lot like getting kids to eat their greens. Despite being told it’s good for them, it tastes disgusting. “They all taste foul,”Voss admits.

“These drugs are bitter and nasty-tasting. Even if you try and crack a tablet, you’ll find how bitter these are they’re not nice to take.”

But it’s much more complicated than that. Voss says adherence is dependent on a stable family structure which is well supported, either internally or externally by support services, in helping families cope with a diagnosis which, in most cases, is not just about the child.

“These kids are not in isolation. In most cases, the child has been born into a family where the mother already has the disease, possibly the father, and possibly another child,”Voss explains. “Then I can have the situation where the child’s infected, already an orphan, and being cared for in a non-HIV family situation with non-HIV infected caregivers.”

Voss adapts her adherence regime to suit her families.

“If they’re in a situation where their parents are on drug treatments, then often what I would like is for the child to be on a similar drug combination, so that they can all do it together,” she explains. “The family will work it out and they will all take their meds together - as the parents organize their own drugs then they’ll be able to organize the kids.”

She’s full of praise for the work of the Community AIDS Resource Team (CART), who help to hold difficult situations together. They help families to avoid crises, or step in to assist if and when they do reach crisis stage.

“When I start a child on medication, I often have to bring them into the hospital, which of course disrupts their routine,”Voss explains. “We get them in, nurses supervise and help give them the medication. But then they go back home into their own routine, and they need somebody to be coming into their home and making sure that they’re taking it regularly and on time.”

Currently, a lack of resourcing means that Voss has no community support people with experience of paediatric drug-taking who can assist families on new drug regimes.

“I’ve got one family where I’m needing to change the

medication. They’ll really need somebody going into their home every day to help them, to get the kid to take it, and it’s not working, you know, we’re not succeeding very well [in that area].”

The stigma of having HIV in your family makes reaching out for help much more difficult than in other circumstances, which means that CART and the hospital are often the only lifelines available.

“There’s not much of a support network for these families, they live in isolation. We have children from all ethnic backgrounds, and some from quite small town New Zealand. A lot of them are terrified about the idea of this diagnosis getting out,”Voss says. “They don’t have anything very much in the way of support groups, because none of them are willing to communicate with others who have it. A lot of them feel their cultural or ethnic groups are too small, and word would get out.”

Voss paints a bleak picture, and when I ask if she knows any families who are open about their status, she thinks for a while. “No. No, basically. They just…can’t.

Can’t deal with it. It’s a very stigmatizing disease and it’s very difficult for the families. And I can understand completely. Some families have been more open and have found that, in retrospect, they wish they hadn’t been.”

A particularly disturbing example of a disclosure gone wrong, Voss recalls, involved an extended family member, and led to the HIV positive family being threatened with the information – ‘do I what I want, or I’ll tell everyone what you’ve got’. “Confidentiality is crucial for these families. It’s very difficult to live and work with. We try very hard to make sure their child’s life is as normalized as possible,” says Voss.

Sometimes this can involve a significant amount of juggling with the truth in the presence of her patients.

“There are a lot of issues surrounding disclosure to the child. The child may not necessarily know that they have the disease,”Voss says. “I can be seeing a child from when they’re a baby through to nine or ten years old, and they actually still don’t know why they’re coming to see me.

“I often find the parents are very reluctant to disclose the disease to the child, because of all the guilt, the stigma, the whole association with fear that children will disclose this to somebody else, the questions the child will ask about how they were infected…”

As HIV positive children grow into adolescence and become sexually active, disclosure is increasingly an issue which has to be managed.

“We have a family clinic where the child, the family, the parents come together, to minimise separate clinic

COLLECTIVE THINKING Issue 69 H May 08

“In terms of my work, HIV is a family disease … It’s very different from the experience of being a single woman or a single man with this disease. I don’t think enough recognition is given to the difficulties these families deal with, actually…”

appointments,”Voss explains. “We try to make them on the same day for them. We try to keep the kid well enough so they’re not in hospital. Most of them have very few hospital admissions these days. We aim for a normal lifestyle.”

HIV prevention in the womb The ultimate ‘normal’ lifestyle for a child would be one which is free of HIV, and thanks to the breakthrough of antenatal screening, it has become a reality. If diagnosed early in the pregnancy, an HIV positive mother’s infection may not be passed onto the child.

Despite this being known about for many years, antenatal screening is only now beginning to be rolled out in district health boards around the country, something which Voss describes as “astounding…how many kids are there now who could have been prevented from getting HIV in this country?” she asks. “When you’ve worked with these children, you desperately wish that they’d never got the disease. For the family’s sake as well as their own.”

Learning that your child may be HIV positive in circumstances where steps could potentially have been taken to prevent exposure put extraordinarily cruel pressures on families.

“I remember seeing one family where the diagnosis was made in both parents when the baby was about six weeks of age,”Voss recalls. “The family were just desperate – why hadn’t somebody during the pregnancy ever asked them to have an HIV test? They were a migrant couple whose baby was born in New Zealand. Nobody ever asked them.”

In this case, the child turned out to be HIV negative, but Voss has seen many other cases – with ages varying from six weeks to three months – of babies being diagnosed HIV positive.

“A reasonable number have been picked up because the child has come in sick, or the mother’s presented with an opportunistic infection, and then we’ve tested the children and found the children to be positive.

“We’ve had a number recently when the child has come into hospital for a variety of conditions, and in some cases have been under the care of doctors for some time without an HIV diagnosis being made. Those ones can be the worst – because you go on to make the diagnosis in the mother as well.

“It’s so much better if the child is diagnosed before they get sick. With antenatal screening, not only can we stop pregnant women infecting their newly-born child being

infected, but if there are children already infected, we may be able to treat them before they become unwell and get an opportunistic infection.”

The family disease Voss heads a team of three infectious disease specialists at Starship, with a current caseload of around 25 patients.

It’s a caseload which continues to grow, particularly in the perinatal area – caring for HIV-positive pregnant women to ensure their infection is not passed onto their unborn child.

Although based in Auckland, she has patients from around the country, and acts in an advisory role to specialists at other hospitals dealing with paediatric caseloads. If you want to talk about a New Zealand family’s experiences of living with HIV, she’s your best bet.

“In terms of my work, HIV is a family disease,” she says.

“It’s very different from the experience of being a single woman or a single man with this disease. I don’t think enough recognition is given to the difficulties these families deal with, actually. Because the families keep it quiet.

“I’ve had a number of occasions where the media have come to me, but they won’t take the story any further unless a family comes forward - the family will never, ever come forward,” she explains. “I’ve asked a number but they’re just never willing to.”

The personal impact of a new HIV diagnosis on a family has not diminished since Voss’s experiences in the early 1990s.

“Families are absolutely distraught when they get told this diagnosis. They’re absolutely beside themselves, because often if we make the diagnosis in the child, clearly we’ve just made the diagnosis in the mother, if not the father. It’s a pretty shattering experience, and the family are each going through their individual guilt and issues.”

But given her original mantra of ‘kids get better’, her role at Starship is one she still finds rewarding, despite its complexities.

“One of the reassuring things is to be able to tell the parents that with the medication, we’ll actually keep them alive. We aim for a really good quality of life – I don’t know how long it’ll be, but they’ll have a pretty normal life, and they’ll just get on with it and go through school, and we call it a chronic disease. That part of it has been a wonderful improvement, with the drugs, and that that has led to enabling us to be so positive with these families.”

11

>> FEATURE

PUTTING A FACE ON AIDS The first Candlelight Memorial

By Hank Wilson

This year marks the 25th anniversary of the International AIDS Candlelight Memorial. The first event was held on May 2, 1983 in San Francisco. The only surviving organizer is Hank Wilson – this piece, originally published in the Global Health Council’s Global AIDSLink newspaper, are his recollections of that time.

12

When Gary Walsh proclaimed “we need to do something” near the end of a packed meeting at the San Francisco Gay Democratic Club in 1983, the club president abruptly adjourned the meeting.

I approached Gary and suggested that he call a meeting of people with AIDS. About a dozen guys showed up. Some were pretty weak. Everyone had stories about their own, their partners’, their roommates’ and friends’ shaky health. I was welcomed because I was healthy; they needed my energy and valued my activist experience. I wasn’t diagnosed yet but I assumed I had IT too. We still didn’t know what caused it; we still didn’t have an antibody test and people who had symptoms were already in the relatively late stages of AIDS. There was little coverage in the mainstream media.

One gay paper reported new deaths each week and provided community updates. Another carried no news about the spiraling epidemic because the editor didn’t want to hurt gay businesses. Was it safe to share utensils, toilet seats? Was it safe to kiss? There were many questions, few answers, and lots of rumours, theories and escalating fear.

We heard about mysterious illnesses and infections popping up. We were confronted with a new language and words we could barely pronounce: Kaposi’s sarcoma, pneumocystis, pneumonia, cytomegalovirus, toxoplasmosis, cryptococcal meningitis, lymphadenopathy.

There was confusion, uncertainty and endless questions. Do all lesions ooze? Are they contagious? Do they keep growing and spread to different parts of your body?

What did a swollen lymph node mean? What should you do and how much time did you have?

Everyone worried about time.

Bobbi Campbell debuted as the first public person with AIDS at a Stonewall Democratic Club/community meeting where he allowed more than 60 attendees to view the lesion on his foot. At the rival Alice B. Toklas Democratic Club meeting, Mark Feldman opened his mouth as wide as he could as dozens waited in line to see the Kaposi’s sarcoma lesion inside. My friend, Eric Moore, had cytomegavirus and was going blind at home. He dictated an article for the gay paper about how a newly formed support group was helping him. Most of us didn’t know what a “support group” was, but we knew we needed them.

We remembered the pink triangle and what happened in Germany. How would the community react? Would people with lesions lose their jobs?

Would customers shy away from gay businesses?

We wanted a street action with large numbers of people, something dramatic that would magnetise the media. We knew that San Francisco officials remembered the 1979 White Night rioting where 13 police cars were burned after the murderer of gay supervisor Harvey Milk was convicted of only manslaughter. A huge turnout could leverage funding for needed services and prod community leaders to confront AIDS discrimination.

We wanted to both honour the dead and support the living. We prioritized putting a face on AIDS, so that it would be your son, your neighbour, your co-worker, your uncle, your brother, your dad. Not just numbers of dead, numbers hospitalized, t-cell counts or exotic infections. At that time in the United States, AIDS was visible in only gay men.

Later marches would broaden the face of AIDS to include

COLLECTIVE THINKING Issue 69 H May 08

women, haemophiliacs and children.

We decided to welcome community leaders and elected officials but relegated them to march behind us. All the speakers and everyone on the front line holding the banning had to be people with AIDS. We brainstormed about a theme for the event and instantly agreed on “Fighting for Our Lives”. It was how we felt.

With AIDS deaths spiraling in New York and Los Angeles, we wanted our action to be bigger than San Francisco. With only two weeks until the march, I called both Larry Kramer, a founder of Gay Men’s Health Crisis (GMHC) in New York City and Paul Popham, the current president of the board of directors of GMHC, and told them what we were planning. I figured one of them would see the potential in joining us. They both did.

We suggested using GMHC’s upcoming Madison Square Garden concert, which was already sold out, to announce the Candlelight March. They could turn out the lights, light a candle, and announce the AIDS Candlelight March. We sent them the posters and figured they would tailor the event to their community. Someone also reached out to Los Angeles.

Our media committee outreached to the press. Coming UP, an LGBT monthly newspaper, surprised us by dedicating their whole front and back page to the march.

That was a lifesaver because the Bay Area Reporter, another major gay newspaper, didn’t give us any publicity. Not a word, not a phrase, not a sentence.

Bobbie Campbell and I met with the editor. He wanted to downplay AIDS, afraid that it would harm gay businesses. We were in crisis mode after the Bay Area Reporter blanked us out, so poster distribution and street signs became a priority. Delivering a poster to Walt Whitman Bookstore, the local gay bookstore, I was shocked when the owner refused to allow us to post it. I activated a phone tree and, by day’s end, he relented and requested that we deliver a poster, ASAP. He got over his fear and the poster was featured on the front door.

Our other strategy was to blanket the Castro, Polk and Folsom neighbourhoods with street signs taped to telephone poles, and to make sure there were posters or signs in every

gay bar, gym and bath house. No one could claim that they didn’t know about the march.

The march was scheduled for 7:30pm on May 2.

We arrived a little early and finding hardly anyone there, freaked. “This is really going to be depressing if nobody comes. Maybe we shouldn’t have done this.”

By 8pm, people started coming from every direction and eventually thousands appeared. Possibly, people weren’t sure if anyone else was going, so they came with some hesitation.

When three nurses came up the escalator together in their white uniforms and white hats, I realized we weren’t going to be alone, it wasn’t just us gay guys, we had allies. Incredible numbers of women showed up; the lesbian community turned out en masses. I remember thinking that however many people die, we’ll be okay as a community because we rallied to support and take care of each other.

People in wheelchairs stood out and monitors assured their participation. The sprinkling of weak and sick guys reminded everyone of the crisis we were facing.

You could hear a pin drop for each speaker. Bobbi Campbell exuded a sense of confidence and pride, and shamelessly expressed his expectations of how the richest country in the world should prioritise health services for everyone; Mark Feldman, who was noticeable weak and sick, moved us to tears revealing his fears, his awareness that he was dying, his love for our community, and his anger at a homophobic and unresponsive government. He shared his sense of humour and got us laughing some between our tears.

Bobby Reynolds led a visualisation, sharing his visions for the future and his appreciations for the community support that was manifesting.

Photographers were everywhere – the candlelight effect making everyone a star. TV crews filmed from the sides, the middle, and from every vantage point.

Cheers went up when it was announced that the New York march had drawn thousands and much coverage.

We cheered again when it was announced that Los Angeles and Houston had also put a face on AIDS. Finally, everyone raised their candles in unison and you could feel the sadness, but also the hope, and a strong and powerful sense of community. We were now people “Fighting For Our Lives” TOGETHER.

13

>> By Chris Banks

PRECIOUS MOMENTS WITH THE DYING A former Catholic priest reflects on the early days of New Zealand’s AIDS epidemic

14

For Michael Bancroft, the annual HIV infection rates released by the AIDS Epidemiology Group are far more than just numbers on a page. Armed with the knowledge that these figures are the worst since the early 90s, they take him back to a time when, in his capacity as a Catholic priest, he ministered to dozens of men – the individuals whose tragedies make up the plotting points on the epidemiology graph. Bancroft’s experiences mirror those of a large number of men and women whose religious calling talk them to bedsides and gravesides during the late 1980s, the last time the HIV epidemic peaked in our communities.

He was ordained as a priest in 1987, and says he knew he was gay at the time “but I wasn’t revealing that because it wasn’t appropriate for priests to say ‘I’m gay’”.

His journey began the following year when the thenBishop of Auckland, Denis Brown, asked him if he’d become a member of the Interfaith AIDS Ministry Network, a group of clergy from various mainstream churches who cared for people living with HIV, and those dying of AIDS. “To me that was great because I could get involved with HIV and AIDS but it also meant I had – I’ll call it now – a cover for being involved with gay people.

Very soon after that I started to get to know HIV+ people.”

Within a year he had conducted his first AIDS-related funeral. It was to be the first of many. “Probably the second or third funeral that I took someone came up to me and said ‘You did a damn good job on that funeral, Michael. Can I book you in for mine?’ And as it turned out, I did - about four years later. I know it sounds strange, but I got a reputation for doing good funerals.”

Over the next four years, they came almost to dominate his work. “In my parish work and among people in general that I knew, I would probably have conducted approximately 40 church-related funerals each year. From 1991-94, I was involved with just on 100 AIDS-related funerals in addition to that. So that’s about 25 a year, one every couple of weeks.”

Most of the men Bancroft ministered to were not Catholic, but the comfort he provided during these times went beyond the rigid doctrines which continue to alienate many gay men from the church.

“I think the aspect of illness and the fact that people were confronted with dying meant that some of the realities of their spirit became more important than whether or not they had money, possessions and so on.

I was able to be someone that they could reflect their

spirituality off... It didn’t seem to matter to people that I was a Catholic priest, and I was seen for the person I was.

I could identify without, in any way, seeming to want to push religion down people’s throats. No one ever accused me of doing that.”

The cycle of funerals took its toll on the gay community during that time. “Even the sense of hope that people had was not so great because of the numbers who were dying, numbers who were sick, and the limited amount of possibilities for treatment,” he remembers.

“Psychologically a lot of them gave up. I think they actually started to die psychologically long before their bodies did. There were people all the time attending funerals. You’d get there, hug each other, another tear would be shed, and say ‘well, we’ve lost another friend’.

Some people literally said to me, ‘well one day, Michael, you’re gonna be up there and it’ll be my box you’re standing in front of’. They talked like that. And, in some cases, within weeks or months that literally was it.

Some were too sick to go to their closest friends funerals themselves.”

Bancroft is no longer in the priesthood, but he carries his memories of those times with him in a personal journal entitled “AIDS In Memory – Precious Moments With The Dying”. It contains photographs, thoughts, newspaper obituaries, snippets of conversation, dates and times of passing, names, and most importantly, a sense of humanity and people who each have their own story to tell.

“I am 42, I am gay, I have AIDS, I am a Catholic, I haven’t been to church for 25 years, will you help me to die? I’ve had a good life. I don’t want any doom and gloom.” We prayed with him till 11.15pm. He died at 11.45pm.”

“Kevin sent for me (Ward 9C) [the old infectious diseases ward at Auckland Public Hospital] 6.30pm.

‘What do you want Kevin?’ ‘Just hold my hand’. He talked non-stop for an hour about what he wanted for his funeral then said, ‘that’s it you can go’. He went into a coma at 9pm and died within 12 hours”.

“Perhaps we could say a prayer...”“Now, Mark?”“No, when you come on Sunday.” Mark died on Saturday night (28 years old). “’Could you ‘lend’ me a few dollars? Could you spare me a packet of smokes?’ What would you like most Jason?

– a man! Sorry Father I shouldn’t say things like that to you. Could we pray please? I really appreciate everything

COLLECTIVE THINKING Issue 69 H May 08

“Psychologically a lot of them gave up. I think they actually started to die psychologically long before their bodies did” 15 you do for me. I’m determined I’m going to get out of this bed and fire some fucking sky rockets on Guy Fawkes Day [it was cold and wet but Jason got his wish]. He died later that month (24 years old) The former Father Michael says he is an optimist, despite his experiences. He says there was never a time when he couldn’t see the light at the end of the tunnel, but that in no way diminishes the intensity of the tragedies he witnessed, something we may well be facing again. “I suppose the thing that hits me most apart from the sheer number of people who died was the age of them.

So many guys in their 20s and 30s. In this day and age we can expect to live till we’re 70 or 80. To see all these potentially long lives, good lives, all gone, finished. I don’t think I could ever get used to seeing so many young faces lying in a box.”

- Adapted from an article originally published on GayNZ.com in March 2004.

>> UPDATE

16

Burnett and Awhina Centres move to new locations The New Zealand AIDS Foundation’s Auckland and Wellington-based HIV testing and counselling centres have moved to new locations. All phone, fax and email contacts remain the same.

BURNETT CENTRE CONTACT DETAILS:

AWHINA CENTRE CONTACT DETAILS:

35 Hargreaves St, College Hill, Auckland Ph (09) 309 5560 / Fax (09) 302 2338 Email: contact.burnett@nzaf.org.nz

Level 1, 187 Willis St, Wellington Ph (04) 381 6640 / Fax (04) 381 6641 Email: contact.awhina@nzaf.org.nz

Collective Thinking, the Newsletter for HIV+ people, their carers and supporters, is published quarterly, by the New Zealand AIDS Foundation.

The NZAF registered office is located at: 31-35 Hargreaves St., College Hill, Ponsonby.

PO Box 6663 Wellesley St. Auckland. Telephone (09) 303-3124 Ideas expressed, and information given here are not necessarily representative of the opinions, nor endorsed by, the New Zealand AIDS Foundation, nor the Board of Editors. Publication of the name or photograph or likeness of any person in Collective Thinking is not to be construed as any indication of sexual orientation, or presence in their body of organisms capable of causing illness. Any similarity between individuals named or described in fiction articles and actual person living is purely coincidental. Publication of any letters, articles, photographs is at the discretion of the publishers and the right is reserved to withhold, alter, edit and comment on any article, letter, advertisement published. The list of subscribers is confidential and is not, sold, rented or leased out to anyone at any time.

COLLECTIVE THINKING Issue 69 H May 08

Findings from the largest survey of HIV positive people released

HIV Futures, the largest comprehensive national survey into the health and social experiences of people living with HIV in New Zealand has been released. The study was conducted by Dr Jeffrey Grierson from La Trobe University in Melbourne with the support of the New Zealand AIDS Foundation (NZAF), Body Positive, Positive Women, and a number of community groups.

The first HIV Futures New Zealand survey was released in 2002. The second survey, HIV Futures NZ2, was completed by 261 HIV positive people in 2007.

“This report gives a comprehensive picture of the health and well-being of HIV positive New Zealanders.

It documents the significant improvements in health and wellbeing from the original survey conducted six years ago.” said Dr Grierson.

“However, there are still major challenges for people living with HIV that include maintaining a good level of health, and participating fully in their communities,” Dr Grierson says.

“The release of this report provides a critical opportunity to reflect on the response to HIV in New Zealand, and to ensure future efforts benefit all people with HIV in this country.”

The use of antiretroviral medication has increased (2001: 64%, 2007: 73%) with a very large reduction in those reporting difficulties using these treatments (2001: 79%, 2007: 44%), as well as a decrease in the difficulties with drug timing (2001: 44%, 2007: 24%). This can be attributed to greater access to the newer treatments, which have reduced the pill burden and side effects.

People are taking shorter treatment

breaks (2001: 45 days, 2007: 28 days), and are more likely to have discussed this break with their doctor first (2001: 43%, 2007: 65%).

“It is heartening to know that the increase in availability of treatments for people with HIV has had such a positive result; however it is clear that there are still several social issues related to an HIV diagnosis that still need to be addressed. Any unwanted disclosure of a person’s HIV status, with the associated stigma, and even discrimination that results is unacceptable in today’s society.” says NZAF National Positive Health Manager Eamonn Smythe.

In 2007 a higher proportion of participants reported being in paid employment (2001: 53%, 2007: 62%), particularly in full time employment (2001: 38%, 2007: 44%).

While the purchasing power of this population has increased (median weekly personal income has increased 2001: $330, 2007: $486), it remains lower than the remainder of the New Zealand population.

Fewer people reported that their HIV status had been disclosed without their permission in the past two years (2001: 33%, 2007: 19%). For two thirds of these people the disclosure had negative consequences.

“Most of the results from this study show improvements for people living with HIV in New Zealand over the last six years – some of them quite considerable,” says NZAF Research Director Tony Hughes.

“In essence, greatly improved treatment options led to better personal health and well being.”

17

Hughes says.

“The NZAF will take this opportunity to ensure services in the future for HIV positive people are planned using relevant and up to date research,” says Smythe.

The HIV Futures NZ2 survey, Matearaikore a muri ake nei (Tuarua) was conducted by the Australian Research Centre in Sex, Health and Society in collaboration with the New Zealand AIDS Foundation The survey was funded by the New Zealand Ministry of Health and was supported by funds from the Australian Government Department of Health and Ageing, and the New Zealand AIDS Foundation.

>> Health & Wellbeing

LIVING WITH HIV IN 2008 What’s changed in New Zealand?

In April, findings from New Zealand’s largest comprehensive study into the health and social experiences of people living with HIV, HIV Futures, was released.

The study, conducted during 2007, collected information on all aspects of living with HIV, including the effectiveness of treatments, social isolation, relationships, employment, housing and finances.

The last study was held in 2002, and researchers are keen to identify whether needs highlighted in the last report have been addressed. The summary report below highlights the key differences between the 2002 and 2007 studies.

18

HEALTH

TREATMENTS

HIV Antibody Testing

Antiretroviral Therapy Use

A higher proportion of respondents reported having received pre-test counselling or engaging in a pre-test discussion than in 2001. This includes those testing positive in the two years prior to survey, where this increased from 6% to 22%. Post-test counselling rates remained the same.

Similar proportions of respondents had ever used antiretroviral treatments (2001: 78%, 2007: 79%), while current use was slightly higher (2001: 64%, 2007: 73%).

A smaller proportion of PLWHA reported having difficulties using these treatments (2001: 79%, 2007: 44%).

This was reflected in lower proportions reporting sideeffects (2001: 44%, 2007: 26%) and difficulties with drug timing (2001: 44%, 2007: 24%).

Current Health Status General ratings of health status and well being were similar across the two surveys. A greater proportion of respondents had been diagnosed with an AIDS defining illness in the two years prior to survey in 2007 than in 2001 (14% vs. 5%). HIV-related and other health conditions A smaller proportion of respondents reported HIV related illnesses (2001: 36%, 2007: 25%).

Mental Health In 2007 a slightly smaller proportion of respondents reported taking antidepressant medication in the prior six months (2001: 23%, 2007: 19%) while a greater proportion reported taking anti-anxiety medication (2001: 15%, 2007: 23%).

Viral Hepatitis Vaccination rates were higher for hepatitis A (2001: 44%, 2007: 54%) and hepatitis B (2001: 48%, 2007: 57%).

Lifetime diagnoses were slightly lower for hepatitis A (2001: 14%, 2007: 11%) and hepatitis B (2001: 18%, 2007: 14%). Hepatitis C rates were similar.

Attitudes to Antiretroviral Therapy Overall, the profile of attitudes to antiretroviral treatment was similar.

Treatment Breaks Similar proportions of respondents in the two studies had ever taken a break from antiretroviral treatments. The median length of the most recent break was shorter (2001: 45 days, 2007: 28 days). Respondents were more likely to have discussed this break with their doctor before taking it (2001: 43%, 2007: 65%).

Antiretroviral Resistance A slightly higher percentage of people had undergone resistance testing in the most recent survey (2001: 19%, 2007: 22%). However, a smaller proportion reported that testing had identified resistance to any treatments (2001: 74%, 2007: 51%).

COLLECTIVE THINKING Issue 69 H May 08

Dosing and Adherence A smaller proportion of participants reported taking antiretroviral medication twice daily (2001: 66%, 2007: 53%) while a higher proportion reported taking treatment three times per day (2001: 9%, 2007: 23%). Adherence, measured by the proportion not missing any doses in the two days prior to survey, was slightly higher in the most recent survey (2001: 80%, 2007: 92%).

Complementary Therapies Use of complementary therapies was similar across the two surveys, although in 2007 more reported taking vitamin or mineral supplements (2001: 30%, 2007: 47%).

SERVICES Health Services A higher proportion of PLWHA reported seeing an HIV outpatient specialist as their primary HIV physician in 2007 (2001: 77%, 2007: 80%). A slightly lower proportion saw a different doctor for HIV specific and general health care (2001: 74%, 2007: 71%). Slightly fewer had visited an outpatient HIV specialist in the six months prior to survey (2001: 82%, 2007: 79%).

Other Services Generally, service use was lower across all services at HIV organisations and other organisations in the most recent survey. For example, at HIV/AIDS organisations: treatments advice (2001: 55%, 2007: 34%); treatments information (2001: 26%, 2007: 15%); and counselling (2001: 48%, 2007: 31%).

Information Participants cited similar organisations and sites as important sources of information in the two surveys.

There were slight differences in the proportions citing HIV magazines and newspapers (2001: 32%, 2007: 28%) and internet sources (2001: 24%, 2007: 30%).

Involvement with HIV/AIDS Organisations Fewer had contact with HIV/AIDS organisations (2001: 77%, 2007: 62%), although the type of contact was consistent across surveys.

THE SOCIAL WORLD OF PLWHA Contact with Other PLWHA A slightly smaller proportion of respondents reported that they knew other PLWHA (2001: 84%, 2007: 80%) and a slightly higher proportion said they spent no time with other positive people (2001: 40%, 2007: 45%). A smaller proportion had been involved in the care of someone else with HIV (2001: 22%, 2007: 16%), and a smaller proportion also said that someone close to them had died of HIV/AIDS (2001: 70%, 2007: 62%).

Disclosure Disclosure of HIV status to others was similar across the two surveys. A smaller proportion reported ever experiencing unwanted disclosure (2001: 54%, 2007: 48%) and unwanted disclosure in the previous twelve months (2001: 33%, 2007: 19%).

Social Support Patterns of social support differed somewhat between the two surveys. Similar proportions reported ‘a lot’ of support from partners (2001: 80%, 2007: 78%) and close friends (2001: 53%, 2007: 51%), while more reported this for PLWHA groups (2001: 13%, 2007: 52%).

Planning for the Future The percentage of respondents reporting that they planned only one day at a time had decreased slightly (2001: 25%, 2007: 20%) and the proportion planning more than one year in the future had increased (2001: 55%, 2007: 60%).

Relationships and Sex A slightly lower percentage reported having no sexual relations at present (2001: 40%, 2007: 32%). Similar percentages were in regular relationships (2001: 41%, 2007: 43%). Slightly more reported casual partners plus a regular relationship (2001: 13%, 2007: 16%) or casual partners only (2001: 23%, 2007: 25%).

A smaller proportion said they would prefer a relationship with someone who is also HIV positive (2001: 34%, 2007: 27%). Similar patterns were observed

19

>> Health & Wellbeing

Copies of the full reports can be obtained by contacting the New Zealand AIDS Foundation or the Australian Research Centre in Sex, Health and Society at La Trobe University. The report is also available online at www.nzaf.org.nz

regarding the impact of HIV on sexual relationships and sexual pleasure. A considerably smaller proportion of participants reported that they would not practice safe sex if a vaccine became available (2001: 70%, 2007: 20%).

Slightly more of those in regular relationships had an HIV positive partner (2001: 21%, 2007: 28%). Larger proportions reported having anal or vaginal sex with their regular partner in the previous six months (2001: 29%, 2007: 40%).

A higher proportion of respondents reported having sex with a casual partner in the previous six months (2001: 36%, 2007: 52%).

Most recent casual partner A higher proportion of participants provided data on their most recent casual partner in the six months prior to survey (2001: 22%, 2007: 49%).

Fewer of these sexual episodes involved anal or vaginal sex (2001: 89%, 2007: 71%). Patterns of condom use with most recent casual partner were, however, the same.

Legal Issues around disclosure of HIV status

20

There were some noticeable changes in the response to items concerning the legal issues around disclosure. A considerably higher proportion of participants agreed with the statement it is legally OK for someone to use a condom for anal or vaginal sex and not to tell their partner about HIV status (2001: 38%, 2007: 63%), while a smaller proportion agreed with the statement it is legally OK for a person to disclose their HIV status to a partner and then not use a condom for anal or vaginal sex (2001: 70%, 2007: 61%).

Recreational Drug Use Rates of recreational drug use were similar between the two surveys, with the exception of tobacco use (2001: 46%, 2007: 38%)

HOME, WORK & MONEY Accommodation A greater proportion of participants owned or were purchasing their own home in the most recent survey (2001: 37%, 2007: 46%). More were also in private rental accommodation (2001: 28%, 2007: 31%) and fewer were in public rental accommodation (2001: 18%, 2007: 13%).

A higher percentage reported that their current accommodation was suitable for their needs (2001: 78%, 2007: 89%). A higher percentage of participants lived by themselves (2001: 30%, 2007: 37%) and with pets (2001: 51%, 2007: 59%) and had access to a car (2001:75%, 2007: 82%).

Employment In 2007 a higher proportion of participants reported being in paid employment (2001: 53%, 2007: 62%), particularly in full time employment (2001: 38%, 2007: 44%). Among those working, more reported that HIV had

COLLECTIVE THINKING Issue 69 H May 08

If you want more information and have not received a copy of the report , it can be downloaded from the NZAF website on http://www.nzaf.org.nz/articles.php?id=950 or if you contact me on Eamonn.smythe@nzaf.org.nz I would be pleased to forward you a copy.

an impact on their capacity to perform their work duties (2001: 44%, 2007: 67%).

Smaller proportions of respondents reported that they had disclosed their HIV status to at least one person in their workplace (2001: 54%, 2007: 49%), and that they did not try to keep their HIV status confidential at work (2001: 22%, 2007: 13%).

Finances A considerably greater percentage of respondents reported their main source of income as a salary (2001: 39%, 2007: 46%) and less reported this as a government benefit (2001:47%, 2007: 36%).

Median weekly personal income has increased (2001: $330, 2007: $486), and this is greater than the change in consumer price index (HIV Futures 47.2%, NZ CPI +16.4%) indicating that there has been an increase in the purchasing power of this population. Median income, however, remains lower than the remainder of the New Zealand population.

Difficulty paying for goods and services has reduced between the two surveys. The proportion reporting that it is somewhat or very difficult to pay for basic needs is lower in the most recent survey: clothing (2001: 66%, 2007: 56%); utilities (2001: 63%, 2007: 50%); housing (2001: 60%, 2007: 53%); food (2001: 54%, 2007: 47%); transport (2001: 55%, 2007: 52%).

While these changes are in a positive direction, it should be noted that there is still considerable financial hardship for PLWHA. A smaller percentage of respondents on a government benefit reported that they had received an assessment from a WINZ medical officer (2001: 62%, 2007: 35%).

Discrimination Fewer reported experiencing less favourable treatment in relation to accommodation (ever 2001: 12%, 2007: 4%), (two years prior 2001: 5%, 2007: 2%).

Fewer reported experiencing less favourable treatment at health services (ever 2001: 31%, 2007: 22%), (two years prior 2001: 20%, 2007: 11%).

Fewer reported experiencing less favourable treatment in relation to obtaining insurance (ever 2001: 36%, 2007: 26%).

Findings are reproduced from: J Grierson, M Pitts, M Whyte, S Misson, A Hughes, P Saxton and M Thomas (2002) HIV Futures New Zealand (Mate araikore a muri ake nei): Monograph Series Number 32. The Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia J Grierson, R Thorpe, M Pitts, A Hughes, P Saxton, J Smith, E Smythe, M Thomas (2008) HIV Futures New Zealand 2 [Mate araikore a muri ake nei (Tuarua)], monograph series number 66, The Australian Research Centre in Sex, Health and Society, Latrobe University, Melbourne, Australia.

21

>> Health & Wellbeing

22

COLLECTIVE THINKING Issue 69 H May 08

Combination therapy –

What, why, when & other questions...

By Simon Collins from i-Base

Combination therapy is the term for using three or more drugs to treat HIV. Treatment works for women, men and children. It works no matter how you were infected with HIV. At some point, most HIV-positive people will need treatment. It is recommended to start treatment before your CD4 count falls below 200.

What is combination therapy?

Combination therapy is the term for using three or more drugs to treat HIV. It is also called triple or quadruple therapy or HAART (Highly Active Anti-Retroviral Therapy).

HIV drugs are also called ARVs. These drugs work in different ways and at different stages of the HIV life cycle.

Do the drugs really work?

In every country that uses HAART, AIDS-related deaths and illnesses have dropped dramatically.

Treatment works for women, men and children. It works no matter how you were infected with HIV. Whether this was sexually, through IV drug use, or by blood transfusion.

Taking HIV drugs, exactly as prescribed, will reduce the virus in your body to tiny amounts. This then lets your immune system recover and get stronger by itself.

Regular monitoring, using blood tests, will check that the drugs continue to work H Viral load tests measure the amount of HIV in your blood. Results are given as copies/mL. H CD4 tests measure how strong your immune system is.

Results are given as cells/uL. uL is an abbreviation for microlitre, a standard measurement for volumes of liquid. The same volume is also called a cubic millimetre which is abbreviated to mm3 Even if you start with a very low CD4 count, you could regain enough of your own immune system for your body to recover from many HIV-related illnesses.

If you use HIV treatment at the right time, and in the right way, you should stay well much longer.

How long will the drugs work?

Combination therapy using at least three drugs has now been used for over ten years. Many of the individual drugs have been studied for even longer.

The length of time that any combination will work depends mainly on you not developing resistance. This depends on getting, and keeping, your viral load to undetectable levels, below 50 copies/mL. If your viral load stays undetectable, you can use the same combination for many years.

UK guidelines state that getting your viral load below 50 is a main goal when starting treatment.

Does everyone need treatment?

At some point, most HIV-positive people will need treatment. When people will need it though, can vary a lot. HIV infection progresses in different people at very different rates.

H About one third of HIV-positive people will stay well for up to 10 years after infection, even without treatment.

H About 60% will start treatment after 4-5 years.

H 2-3% of people can become ill more quickly and need treatment much earlier.

H 2-3% can go for 15-20 years without treatment.

Whether you need treatment is something you have to discuss with your doctor. This will usually take place over several visits.

When discussing treatment: H Ask as many questions as possible until you are happy with the answers.

H Get useful information from other sources. This includes the internet, friends, newsletters and phonelines.

Even if you are well, it is a good idea to get to know something about treatment now, before you need it. This is particularly important if your CD4 count is falling, or if you have a high viral load.

23

>> Health & Wellbeing

When should I start treatment?

24

When to start treatment is something you and your doctor must discuss together. You are the person who has to take the pills. So you have the choice over whether you start, as well as which drugs you use.

It is recommended to start treatment before your CD4 count falls below 200. Even at this level, there is unlikely to be an urgent need for you to start treatment straight away, if you are not ready.

H Ask your doctor to tell you about the different drugs that you can use. You need to know the good and bad things about each of them.

H Take time to think about what you want to do. Do not feel rushed or pressurised into doing something you don’t understand. If you have only recently been diagnosed HIV-positive, you will need to deal with that first.

Although you may be worried about using treatments, HIV and AIDS is still a very real and life-threatening illness. It is possible to delay treatment until it is too late.

Illnesses that can occur at any time when your CD4 count is below 200 can be fatal.

While your CD4 count is above 300 you still have a good immune system. Below 300 you are at a higher risk of infections that cause diarrhoea and weight loss.

If your CD4 count falls below 200, your risk of developing a pneumonia called PCP increases. If it falls below 100, then your risk of serious illnesses increases even further.

A low CD4 count does not mean that you will definitely become ill. It is, however, much more likely. Most of the drugs used to treat these HIV-related illnesses can be more toxic and difficult to take than regular anti-HIV drugs.

Don’t look at the drugs you start with now as a treatment that you will be taking forever. Look at them as something you have to be really committed to for the next couple of years. Take this new aspect of your life more seriously than anything else until you get it right.

COLLECTIVE THINKING Issue 69 H May 08

“Don’t look at the drugs you start with now as a treatment that you will be taking forever. Look at them as something you have to be really committed to for the next couple of years. Take this new aspect of your life more seriously than anything else until you get it right.”

Different drugs work at different stages of the HIV life cycle HIV uses CD4 cells as factories to make hundreds of copies of itself - entry inhibitors and CCR5 inhibitors stop HIV getting into the CD4 cell, nukes & non-nukes (NNRTIs) block one of the main ways HIV reproduces inside the CD4 cell, integrase inhitors stop the virus from integrating into the cell DNA, and protease inhibitors stop any new genetic material from being cut and reassembled into newly infectious HIV..

What about side effects?

Everyone considering HIV treatment worries about side effects. But most people find that, within a few weeks, taking treatment becomes an ordinary and manageable part of their daily life.

H Most side effects are usually mild.

H They can often be reduced with other medication that is easy to use.

H There is only a small risk of serious side effects, and these should be picked up by routine monitoring.

Regular blood tests will check for some side effects. If you have any difficulties make sure your doctor takes these seriously. Nausea and fatigue can be very serious.

Ask your doctor, nurse or HIV pharmacist about the most common side effects of the drugs that you want to use. Ask how likely they are to occur. Ask how many people stop treatment because of them (usually very few). Even rough estimates will give you a good idea of what is involved.

Nausea, diarrhoea and tiredness are the most common general side effects. These often become easier after the first few weeks. This is why you should tell your doctor of any problems.

Ask your doctor or pharmacist for anti-nausea and diarrhoea medications when you first start therapy so you can use these as you need them.

If these medications aren’t effective, ask your clinic for stronger or more effective drugs.

Lipodystrophy Lipodystrophy refers to changes in blood fat and blood sugar levels. It also includes changes in fat cells and the distribution of body fat.

It is a set of side effects that is a worry for many people who are about to start treatment.

However, most severe cases of lipodystrophy are in people who have used many different drugs, or have used treatment for many years.

Newer drugs used in first-line therapy are less likely to cause these problems. The greater awareness of lipodystrophy today means that you will be monitored carefully. You can change treatment if you get low-level symptoms.

Different drugs may be responsible for fat gain and fat loss. Fat accumulation, to the stomach or breasts and/or across the shoulders, has been more linked to protease inhibitors and NNRTIs. Fat loss, from arms, legs, face and buttocks, has been linked to nucleosides. This is mainly to d4T, and to a lesser extent to AZT. We do not know what causes lipodystrophy.

Lipodystrophy usually, but not always, develops slowly over many months. Early symptoms may reverse if you switch to different HIV drugs. Exercise and dietary changes can also help. Careful body measurements by a dietician, by DEXA scan, or photographs can monitor changes.

Other side effects Regular blood tests will check for other side effects. If you have any difficulties make sure your doctor takes them seriously and does something about it.

Side effects that are more serious occur rarely with most combinations. They also relate to specific drugs. It is important to be aware of those associated with the drugs that you will use before you start treatment.

Because some of these symptoms include rash, nausea and tiredness that are common side effects themselves, it is important that your doctor knows about any difficulty you are having.

This text is from the i-Base Introduction to Combination Therapy, which also includes sections on adherences, resistance, choice of drugs and your rights as a patient. Download a full copy at online at: www.i-Base.info

25

Disclosing HIV in th

One Personal Perspective From

By Steve McMahon

26

Disclosing one’s HIV status in the workplace is a complex and emotional issue, with many different variables to consider. I’ve made the decision to share my HIV-positive status with my co-workers and I’ve been rewarded handsomely for it. It’s not an easy to “come out of the closet” so to speak, but if one is careful in how they do it, it can be both a positive and rewarding step. The following is an account of what I went through.

Soon after starting my first round of medicines, I began experiencing neuropathy in my legs. It became such an issue that I would be in a lot of pain if I had to stand up for my commute to work on the train. So I decided to confide in my boss, and see if she would adjust my schedule to allow me to come in a half hour early every day so that I’d have an easier commute. I was so nervous that day, wondering what she would think of me.

I stopped by her office one morning when she was in between meetings, and asked to speak to her privately.

I then told her of my condition and how the medicines were causing me pain in my legs and feet. I was careful to stress that I was not looking for special treatment, only reasonable accommodation. It turns out that all that stress was for nothing. She was very understanding and immediately offered to adjust my schedule.

I found that it was easiest to let people know about my status by dropping small hints. For example, I stopped hiding my morning medicines from everybody, and began taking them at my desk. If a co-worker asked me what I was taking, I would tell them that these are my morning medicines. If they asked anything further, I would take them aside to speak to them privately and tell them about my HIV. It’s important to remember though, that AIDS still scares people, and that many people still don’t know a lot about it. If I had to leave work in the middle of the day for a doctor’s appointment or if I happened to be going through a bout of bronchitis, I decided that in my case it was much easier just to be honest about what I was going through and if someone was curious, I would explain why I was getting sick and how I planned to get better.

Whenever I disclose my HIV status to someone in the office, I always offer to answer any questions they may have and reassure them that I’m not dying and I’m not sick. I explain that being HIV-positive is now considered a chronic condition, and that with drug therapy and

COLLECTIVE THINKING Issue 69 H May 08

Tell us about your experiences of HIV in the workplace, positive or negative, by emailing

c.thinking@nzaf.org.nz

he Workplace

m the Corporate World reasonable lifestyle changes, such as a regular exercise regimen, I’ll probably not become seriously ill for quite some time. I’ve noticed that once I’ve disclosed my status to someone in the office, they tend to treat me with respect and my relationship with that person tends to be closer, most of the time. It’s also a lot easier to take the time I need when I’m not feeling better when the people I work with know of my condition. My department as a whole understands, rather than resents, that sometimes I may not be up to my full potential.

I have a different boss now, and he found out after I was in the hospital for a week with bronchitis that required the use of intravenous antibiotics. When I came back to work, I asked him if he’d heard about my HIV, and he stated that he had. As with my previous boss, I reassured him that I didn’t want special treatment, just reasonable accommodation. To his credit, he’s been one of the best bosses I’ve ever had. He doesn’t question when I call in sick, and always accommodated any request I have for time off during the workday to fill prescriptions, go to the doctor’s office, or whatever else I may need to do.

I’ve received a lot of support from people at work since “coming out” with my status, but I’ve also had some people back away from me. That is bound to happen to everyone. Telling people you have HIV is not a small thing for many people to swallow and, frankly, it just makes some people nervous. This is something that one must thing about very seriously before making the decision to let people know what you are going through.

The reality, of course, is that each individual must make the decision to disclose based on his or her own situation.

The medicines do cause side effects for many people, as do the medicines that treat the side effects. But in some cases it may actually cause more stress to let people know of your situation, which can adversely affect your health as well. But if you spend a little time, as I did, weighing out the options, you should be able to decide which course is best for you.

All in all, my decision to disclose my HIV status at work has left me with less stress, more support, and a better relationship with most of my coworkers. And thanks to the support I’m receiving and the stress I’m not dealing with, I’m feeling pretty healthy, and pretty happy. Life is good.

Reprinted from TheBody.com

27

>> OPINION

A Lad and His Dog

By Carlos A. Perez / Reprinted from TheBody.com

28

You may be aware of the studies showing that people who own pets have a better chance of living healthier lives. In many studies researchers have found blood pressure levels of pet lovers to be lower than “pet-less” people, as well as many other indicators of overall wellness. Well, I am here to tell you they are right.

I was going through some life challenging and altering events. These events are the direct results of the madness of being HIV positive. I was years into disability and not finding the right thing to do, I had not ventured into volunteering or doing anything meaningful with my time. I had thrombocytopenia, peripheral neuropathy, and of course, depression. I had figured out one thing about helping myself. I needed to have a reason to come home, every day. I needed a routine for myself that did not consist of pleasure 24/7 or, at least, cut back a bit and decrease my risk factors.

The idea of a puppy was on the back burner. It sounded great but it was almost like committing to a relationship.

Been there, done it, bought the tee shirt, didn’t fit. One day my brother told me about a doggie, a Pit-Bull doggie.

I was deep in depression, I thought it can’t hurt and my brother’s company is always action-packed, to say the least. We went to the “hood” where a beautiful bitch had a litter of pups. They were all adorable but one just gravitated towards me. I checked him out and it was definite. I was wearing Dickies overalls and I placed the pup in the front large pocket. We drove away and I started pretending like I liked the dog but I was depressed, I didn’t know what to feel. After a couple of turns he puked on my Dickies. That’s what I named him.

Dickie was my guardian angel. Besides the fact that he was a blast -- acting like a spastic Tasmanian Devil -- he made me laugh when I felt like I couldn’t cry anymore.

This animal was so glad to see me. This dog lived for me. I see it like this: they watch you produce food and water for them, they believe you’re God. And you know what God spelled backwards is.

He was the reason I needed to be at home at least twice a day. I tried to go with early morning and late afternoons, you know, mimic society at large. I was still going out.

That was my thing. I was on the “government cheese” and I still saw myself as an HIV victim instead of an HIV survivor. So the clubs were the answer. Besides, they still predicted we were dying of AIDS in “x amount of time” and I believed in “going out with a bang.” I went out to bang just about every night. Dickie helped me get out of

banging and get back in the house. I fell into a routine. I added regular visits to the gym. I started cooking more at home, thanks to Open Hand. I started meditation and one day while walking Dickie I met my partner. Did I mention this routine kept me away from the risk factors?

Little by little I began to realize that Dickie loved me more than the “tricks” did. I fell deeper in love with Dickie. He always wanted to stay with me the following morning just like every other second of the day. He wanted to stay around when my neuropathy hurt so bad I could only lie on the couch and he would lie there beside me. He stayed there with me when I cried in confusion just looking at me with those almond eyes, looking sideways, blinking, understanding me more than the “quickies” did.

We had to put Dickie down after he was about eight years old. He had cancer and to add drama his symptoms were AIDS-like. His lymph nodes were enlarged, his platelet count was very low, and his white cells were out of whack. It was a great loss. I was devastated.

The irony here is that there was one night during my bad spell when I came pretty close to giving up on waiting to die from AIDS. Dickie was there, nobody else.

I remember sobbing because I thought I was giving up on him. I put him in his crate and he knew I was not right.

He was barking and whining at me. He didn’t have to speak words. It was clear to me that he was telling me to “get over it!” I didn’t listen to his barks of wisdom and just drank and drank and did a “Judy Garland bender.”

Major hangover.

The next morning when I came out of my stupor I immediately realized the poor dog had not been out in hours, I mean like twenty-four of them! He was in his cage, which was clean as a whistle, and he looked so happy to see me. We were outside in no time. He was walking proudly, like Pits do with their chest flared and their butt shimmying from side to side and I had to smile.

Dickie had pulled me through one of my darkest times and put me back on my routine. It worked for me. I have another angel now -- another Pit-Bull, named Papi.

Cats, ferrets and Savannah monitors will do as well, I’m just a doggie-kind-of-guy. But believe me they can help. There’s nothing like having to care for another living thing when you’re not yet sure how to care for yourself.

Carlos Perez is the editor of the Chicago Area HIV Services Directory and Information Services Coordinator at Test Positive Aware Network.

COLLECTIVE THINKING Issue 69 H May 08

“Dickie was my guardian angel.

Besides the fact that he was a blast – acting like a spastic Tasmanian Devil – he made me laugh when I felt like I couldn’t cry anymore.”

29

WOMEN AND HIV– FIGHTING THE STIGMA Positive Women’s destigmatisation campaign, launched in February, seeks to put a human face to an anonymous illness by the telling the stories of real New Zealand women living with HIV.

30

Wellington postie, Beate Lutz, says the campaign is about making the public realise that contracting HIV can happen to anyone. Since contracting the virus from her husband, she has encountered a lot of wrong assumptions and bizarre beliefs.

“The fallout of being diagnosed was so hard. A friend came to stay once and brought her own towels, cups, food – everything. She wouldn’t even let our daughters have baths together,” she says. “There’s a lot about this disease you just have to put up with, but feeling ashamed and dirty is something we should be allowed to live without.”

“People don’t know much about HIV and so they fear it. I want people to be aware that there are women as well dealing with this and we should not each feel alone.”

Southland grandmother Jan Waddell contracted HIV from a contaminated needle while nursing, a “one-in-amillion” occurrence.

“The container for disposing used needles fell and instead of the needle going into the container, it went into my thumb,” she says. “I knew my patient was HIV positive but I didn’t panic. I took the preventative medicines and tried not to think about it, but they didn’t work. I got sick, really sick, and was diagnosed with HIV.” She counts herself lucky in having supportive family and friends when she knows of many other HIV positive people who have lost their jobs, and contact with family members or friends.

“The stigma attached to HIV is a fear of the unknown,” she says. “A lot of people have this strange idea that we are different, they are afraid of us, and so, whenever possible avoid any contact with us. We are no different to

anyone else and that’s the message we need to get across.”

Jan agreed to be a Positive Women campaign face because she sees a big need for more education about the HIV virus – the risks, transmission and prevention.

“Unless people hear a voice or see the face of HIV, their misconceptions and the resulting stigma will stay.”

Jewel Grimshaw was only 16 years old when she contracted HIV from her fiancé. Now in her early 30s, she has been living with the virus for more than decade.

“I just went into complete shock,” she says, recalling her diagnosis in an interview with the Central Leader. “Then I was angry, then it went to sadness. Then I thought: ‘Oh, I’ve got to live my life.”

Jewel has always been open about her diagnosis, something which hasn’t always been easy. “I’ve had to deal with a lot of rejection. People freak out – they don’t understand. There is a group of us who got together to try to stop the wrong ideas and the wrong treatment out there.”

Jane Bruning is the National Co-ordinator for Positive Women, and she has also chosen to tell her story as part of the campaign. “I hid it [my diagnosis] for years, trying to pass as ‘normal’, all the while feeling like I was poisonous.

I felt dirty and contagious, even a danger to society.”

Jane had been living with HIV for fifteen years before she decided to ‘come out’ in the most public way – on national television for an item on TV One’s Breakfast programme. “It was terrifying, but I felt I was finally living my life,” she says. “I want that for other HIV positive women. I want a world where we don’t have to hide anymore.”

Free Phone: 0800 POZTIV (0800 769 848) Free Phone: 0800 POZTIV (0800 769 848) www.positivewomen.co.nz www.positivewomen.co.nz email: positivewomen@xtra.co.nz email: positivewomen@xtra.co.nz

L6=>C: L6=>C: @6=6 @6=6

LDB6C A>K>C< L>I= =>K LDB6C A>K>C< L>I= =>K

" L]V`ViVj`^ 路 Ij `V]^`ViZV ^ iZ jgj

I=GDJ<= JC>IN 8DB:H HIG:C<I= I=GDJ<= JC>IN 8DB:H HIG:C<I= " L]V`ViVj`^ 路 Ij `V]^`ViZV ^ iZ jgj

ADD@ 7:NDC9 I=: HI:G:DINE: ADD@ 7:NDC9 I=: HI:G:DINE:

COLLECTIVE THINKING Issue 69 H May 08

31

Mali Malta Mauritius Mexico Moldova Morocco Myanmar Namibia Nepal Netherlands Antilles Netherlands New Zealand Nigeria Northern Mariana Islands Pakistan Panama Papua New Guinea Peru Philippines Poland Puerto Rico Romania Russia Rwanda Saint Kitts and Nevis Samoa Saudi Arabia Senegal Seychelles Sierra Leone Singapore Somalia South Africa South Korea South Sandwich Islands Spain Sri Lanka Sudan Suriname Swaziland Sweden Taiwan Region Tajikistan Tanzania Thailand Togo Trinidad and Tobago Turkmenistan Uganda Ukraine United Kingdom United States Uzbekistan Venezuela Vietnam Virgin Islands Yugoslavia Zambia Zimbabwe

www.candlelightmemorial.org

May 18, 2008

Never Give Up, Never Forget

Afghanistan Angola Antigua and Barbuda Argentina Armenia Aruba Australia Azerbaijan Bangladesh Barbados Belarus Benin Bosnia and Herzegovina Botswana Brazil Burkina Faso Burundi Cambodia Cameroon Canada Central African Republic Chile China Colombia Cook Islands Cote D’Ivoire Croatia Czech Republic Dem Rep of Congo Dominican Republic Egypt El Salvador Estonia Ethiopia Fiji French Polynesia Gambia Georgia Ghana Grenada Guatemala Guinea Guyana Haiti Honduras Iceland India Indonesia Iran Ireland Italy Jamaica Kazakhstan Kenya Kyrgyzstan Laos Liberia Lithuania Malawi Malaysia

www.nzaf.org.nz

Tauranga – 7pm at the Memorial Park Fountain Wellington – 6:30pm at the Ilot Theatre, Town Hall

TO BECOME A COORDINATOR, register online, or send your name, organization or community name, and postal address to: Candlelight Memorial, Global Health Council, 1111 19th Street, NW, Suite 1120, Washington, DC 20036, U.S.A. Email: candlelight@globalhealth.org

A Program of the

Auckland – 6:30pm at St Matthew in the City Christchurch – 7pm at the Art Centre Great Hall Dunedin – 7pm at the St Paul’s Cathedral Hamilton – 7pm at the University of Waikato Chapel Invercargill – 6pm at Bluff Hill

AP Photo/Gurinder Osan

25

Anniversary

th